California Licensed Utilization Review Nurse

Job Summary

A company is looking for a Temp Utilization Review Nurse.

Key Responsibilities

• Review medical records to determine the medical necessity of treatment requests based on evidence-based guidelines
• Evaluate treatment protocols and make recommendations, including negotiating with providers as needed
• Communicate UR determinations with claims examiners, providers, and other stakeholders within prescribed time frames

Required Qualifications, Training, and Education

• Minimum of 3 years clinical experience
• Experience in California Worker's Compensation and Managed Care/Utilization Review is desired
• Familiarity with California Worker's Compensation regulations and medical terminology
• Completion of IEA CA10 is required within one year of employment
• Ability to direct ancillary non-licensed personnel as needed